The Health Vote: A Gamble When Trust in Government is Down

My latest Capital Journal looks at how attitudes toward government affect the politics of the big health vote:

As a piece of social policy, the health bill passed Sunday night by the House of Representatives ranks up there with the Great Society programs of Lyndon B. Johnson in ambition and scope. But here’s one big difference: The Great Society programs were enacted in an era when Americans still tended to trust the government to get things done.

By contrast, a principal reason the health bill was so hard to get to this point, and the reason it’s such a political risk, is that this landmark legislation proposes expanding the government’s role in the giant health economy at a time when Americans are far less likely to trust the government to do things right.

President Barack Obama will sign the core legislation into law, and it’s likely the Senate will also approve a package of changes to that law, which the House passed Sunday night. But how the legislation is perceived by Americans in both the short term and long run may well depend on whether its advocates—Mr. Obama, his Democratic allies in Congress, a variety of labor and health interest groups—can convince Americans that, at least on this giant issue, the government is up to the task.

At a minimum, Democrats will be trying to show citizens that the government can produce outcomes that are at least superior to the status quo in health care, which almost everybody agrees can’t be sustained.

Proponents of the health legislation are quick to point out that it doesn’t amount to a government takeover of health care, and they are right. The legislation builds on, rather than replaces, the employer-based health-insurance system that has prevailed in this country for decades. It funnels patients getting government subsidies into private insurance policies and pools, not a government-run health plan, and is at best a small step toward the nationalized health-care system some liberals want.

So in that sense, it’s a far more modest exercise in social engineering than was the Great Society program of the mid-1960s, which included legislation creating Medicare and Medicaid, the food-stamp program and Head Start, as well as two landmark civil rights acts.

Yet by making the federal government both a much bigger economic player, and a more potent referee, in the private health marketplace, the new health bill represents a similar turn to government action to confront gnawing domestic concerns. What has changed are attitudes toward that government